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GI Flashcards

1
Q

SMA syndrome

  • what happens
  • sxs
  • worse
  • improve
A
  • duodenum compressed by SMA
  • stomach pain
  • eating
  • left lateral recumbent
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2
Q

Obstruction of duodenum

- how to fix

A
  • re-route GI tract so food can bypass blockage
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3
Q

IMA

  • supplies
  • gives off
A
  • distal part of transverse colon, descending, sigmoid,

- inferior rectal a

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4
Q

SMA

  • supplies
  • great colic artery
  • ileocolic artery
A
  • lower duodenum, small intestine, ascending colon, and prox 2/3 colon
  • ascending colon
  • ileum and cecum
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5
Q

What is first part of GI to be affect with hypotension

A
  • splenic flexure, only gets some flow from IMA and SMA
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6
Q

marginal a of drummen

A
  • sits against wall of intestine
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7
Q

arc of riolan

A

runs in mesentary, communicates between IMA and SMA

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8
Q

Blood supply to liver

  • artery
  • runs w
  • pringle manuever: what is it, what does it mean
  • triad anatomy
  • venous
A
  • proper hepatic
  • portal v and bile duct
  • clamp duct, a, v when there is bleed in liver -> if continue to bleed then it is venous
  • ant: bile duct, artery, portal v
  • right, middle, and left hepatic v -> dump into vena cava
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9
Q

Embryology

  • starts as
  • leaves
  • returns
  • turns
  • foregut: includes, a, PS, S, lungs
  • migut: includes, a, PS, S, rotation
  • hindgut: includes, a, PS, S
A
  • straight tube
  • abd cavity through umbilicus at 6 weeks
  • abd cavity at 10 weeks
  • 270 degress counterclockwise
  • esophagus, stomach, liver gall, upper duodenum -> Celiac trunk, PS- Vagus, S: splanchnic; gives rise to lung buds
  • lower duodenum, small intestine, ascending colon, and prox 2/3 colon -> SMA, PS - vagus, S: splanchnic; rotation requires cilia and if have dyskinesia then will have all organs on opp side
  • distal 1/3 of transverse colon, descending colon, sigmoid colon -> IMA, PS: pelvic splanchnic, S: lumbar splanchnic
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10
Q
  • malrotation: cecum, midgut, sxs; worst case scenario; tx
A
  • cecum is in RUQ and held in place by ladds bands; midgut fixed to SMA; newborn baby in first few days of lay has bilious vomitting; malrotation causes necrosis and gangrene of intestines; surgery -> remove bands, remove necrotic tissue -> put everything back in place (cecum will end up in LUQ, so remove appendix)
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11
Q

acute mesenteric ischemia

  • sxs
  • palpation
A
  • pt in excutiating pain but do not see much on PE, signs of sepsis
  • doughy on palpation
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12
Q

Anus

  • upper: contains, mucosa histo, connects to lower w, blood supply
  • lower: histo, blood supply
  • hiltons white line: what is it
  • dentate line: what is it and why is it important
A
  • longitudinal folds/ elevations of mucosa; simple columnar epi; connectes w/ anal valves; sup rectal
  • stratified squamous epi; inferior rectal
  • junction between keratinized stratified squamous epithelium and non-keratinized stratified squamous epi
  • above is rectum w/ columnar epi (colorectal CA) and visceral innervation (painless); anus w/ squamous epi (squmous cell CA) and painful
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13
Q

Retroperitoneal stuctures

  • solid
  • hollow
  • vessels
  • SAD pucker
  • cause of retroperitoneal hematoma in stable pt
A
  • pancreas, kidney, adrenal
  • part 2-3 of duodenum, ascending and descending colon, rectum, ureters, bladder
  • abd aorta, inferior vena cava
  • pancreatic injury w/ venous bleeding
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14
Q

Tongue

  • taste
  • Pain
  • motor
  • ant 2/3 tongue
  • post 1/3 tongue
  • taste
A
  • 7, 9, 10
  • 3, 9, 10
  • 12
  • 1st branchial arch; tast from chorda tympani of CN7, sensation from madibular division of 5
  • 3rd and 4th branchial arches; tase and sensation from CN 9
  • inside taste bud is gustatory cell which has gustatory hair which detects chemical compound you are injesting, activate sensory fibers and they take info to brain
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15
Q

Oral gland innervation

  • PS
  • Symp
  • parotid
  • lingual
  • sublingual
  • submandibular
A
  • increase secretion
  • decrease secretion
  • serous -> CN9
    serous -> CN7
  • mucinous -> CN7; under tongue
  • mucinous -> CN7; under jaw
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16
Q

Saliva

  • 1st step in
  • rich in
  • lipase
  • amylase
  • lysozyme
  • HCO3
A
  • digestive process
  • IgA
  • break down fat
  • begins carb breakdown; bacteria in mouth break down carb -> produce lactic acid -> destroy enamel -> lead to dental carries
  • detergent that binds and reoves things from teeth that get stuck near mucinous secreting glands
  • protect teeth and gum from acid erosion from food, frinks, and reflux
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17
Q

Cleft lip

  • what is it
  • when does it develop
  • what happens
  • caused by
A
  • failure of fusion of maxillary and medial nasal process
  • week 5
  • under dev of of mesenchyme of maxillary swelling causing inadequate contact w/ medial nasal process and intermax process
  • anti-seizure, vit A
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18
Q

Cleft palate

  • develops
  • caused by
  • tx
A
  • 8 weeks - 12 weeks
  • lat palantine process, nasal septum and/ or median palantine process
  • in US fixed immediately but in other countries w/o resources will have to wait till older sometimes even adult hood
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19
Q

Swallowing

- process

A
  • chew food and mix with saliva to form paste -> tongue pushes bolus into post oral pharynx -> soft palate elevates to close nasopharynx -> larynx blocks trachea so you dont aspirate -> bolus goes down esophagus
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20
Q

Muscles of tongue

  • mylohyoid
  • genioglossi
  • styloglossus
  • hyoglossus
  • palatoglossus
A
  • tongue elevation
  • tongue protrusion
  • trough formation
  • tongue depression and retraction
  • elevates post tongue and closes oropharyngeal isthmus; innervated by vagus
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21
Q

Odynophagia

  • what is it
  • bugs
  • healthy person causes
A
  • painful swallowing
  • candida or CMV (cowdry bodies)
  • pill swallowing
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22
Q

Dysphagia

  • what is it
  • progressive worsening
  • chronic
  • paradoxical
  • cardiovascular
A
  • difficulty swallowing
  • stop solids first, then soft food, then liquids; cancer
  • achalasia ->
  • only with liquid
  • dilated left atrium pushing on esophagus; will have mumur and rales with pain
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23
Q

Dysphagia

  • what is it
  • progressive worsening
  • chronic
  • paradoxical
  • cardiovascular
A
  • difficulty swallowing
  • stop solids first, then soft food, then liquids; cancer
  • achalasia -> LES fails to open up during swallowing
  • only with liquid
  • dilated left atrium pushing on esophagus; will have mumur and rales with pain
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24
Q

Achalasia

  • what happens
  • caused by
  • bug
  • dysphagia types
  • barium swallow
  • increased risk of
  • mgmnt
A
  • LES fails to open up during swallowing
  • auerbach/ myenteris plexus -> unopposed PS causing contraction of LES
  • chagas dx -> destroys myenteric plexus
  • chronic and paradoxical
  • bird beak
  • esophageal CA
  • Ca channel blocker and Nitrates -> SM relax (GERD), botox which causes paralysis of muscle 4-6 months of relief, mechanical dilation
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25
Q

Barrets Esophagus

  • what is it
  • caused by
  • common cause
  • management
A
  • metaplasia of squamous epi to columnar epi
  • chronic gastric acid exposure
  • hiatal hernia -> increase in GERD (only 6% chance)
  • should be scoped and biopsied every year to monitor for CA
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26
Q

CA of esophagus

  • squamous: risk, location
  • adeno: common,risk, location
  • sxs
A
  • smoking and EtOH, prox; flattened polyhedral or ovoid elpi with eosinophilic cytoplasm, keratin pearls of whirls; esophageal resection (either pull stomach into chest to attach or take part of colon and put it as a link between stomach and esophagus
  • most common; barrets, distal;
  • weight loss, dysphagia
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27
Q

Mallory Weiss tear

  • what is it
  • caused by
  • bleeding time
  • sxs
  • diff from varices
A
  • longitudinal tear of mucosa at gastro-esoph junction
  • reching, coughing, vomitting
  • EtOH use of eating disorder
  • stop abruptly in 24-48 hrs
  • blood in mouth or melena
  • will vomit bucket of bloods vs only a bit of blood
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28
Q

boerhaave syndrome:

  • what is it,
  • hammans sign ,
  • pleural fluid tap;
  • tx
A
  • esophageal rupture,
  • usually iatrogenic,
  • crunch in precordium that is synchronous with heartbeat;
  • amylase, lipase, w/ contents from saliva
  • drain and resect/ or tie off and give them a feeding tube directly into stomach
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29
Q

zenkers diverticulum

  • what is it
  • caused by
  • sxs
  • sequeleae
  • diff from traction
A
  • false diverticulum that sits about UES
  • congenital or excessive pressure (problem with synchronized contraction, upper and lower muscles squeeze at same time causing increase and pressure and an outpuching)
  • dysphagia, halitosis (food get stuck in out pouching), or asymptomatic
  • problem with synchronized contraction -> peristalsis
  • inflamm process causes adhesion and the diverticulum is caused by pulling and is true vs zenckers is pushed out bc of pressure and it is false
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30
Q

Plummer vinson syndrome

  • triad of findings
  • location
  • increase risk of
  • management
A
  • dyphagia (to solids), esophageal webs, iron def anemia
  • proximal
  • squamous cell CA
  • teat anemia, modify diet to make pt comfortable, only resect rings w/ severe odynophagia
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31
Q

Schatzki ring

  • location
  • sxs
  • management
A
  • web in lower esophagus
  • intermittent dysphagia, and felling of food sticking when swallowing
  • modify diet
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32
Q

Diffuse esophageal spasm

  • what is it
  • sxs
  • triggered
  • imaging
  • tx
A
  • uncoordinated contraction of whole esophageal body (LES remains intact)
  • dysphagia, regurg, severe CP (mimics MI)
  • very hot or cold beverages
  • corkscrew
  • CCB, nitate -> relax muscles, botox or surgical balloon dilation
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33
Q

tracheo-esophageal ridges

  • when
  • sxs
  • imaging
  • H configuration
  • type C
A
  • failure of fusion of tracheoesophageal ridges during 3rd week of embryogenesis
  • on very first feeding baby will vommit of choke
  • see blind pouch and air in stomach if trachea is attached to stomach
  • esophagus attached to stomach and trachea; no vomitting but every feed child will aspirate
  • most common; prox esophagus ends in blind pouch and lower is attached to stomach and trachea
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34
Q

GERD

  • what is it
  • associated w
  • sxs
  • increased risk of
  • DX
A
  • abnormal relax of LES allows stomach contents/acids to move into lower esophagus
  • hiatal hernia
  • heart burn, cough (if acid comes into pharynx), erosion of dental enamel, laryngitis, pharyngitis
  • barrets
  • pH probe, also known as esophageal manometry
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35
Q

Esophageal Varices

  • what is it
  • MCC
  • route
  • dx
  • tx
A
  • overly dilated v in lower esophagus
  • portal HTN secondary to cirrhosis
  • Portal vein -> left gastric v -> superficial esophageal v
  • endoscopy
  • ligate, band or inject them if not bleeding and cauterize or tamponade (with balloon) if bleeding
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36
Q

Anatomy of Stomach

  • orad: where,
  • caudal: where
A
  • middle of body and up; much thinner muscular wall than distal part; higher risk of perforation
  • middle of body and down; rugae are larger and thicker musclar walls; churning
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37
Q

Function of Stomach

  • protein digestion
  • vit B 12
  • gastric resevoir
A
  • occurs mainly in stomach via parietal cells producing HCL and chief cells producing pepsinogen (converted to pepsin with low pH)
  • parietal cells secrete intrinsic factor to allow absorption in terminal ileum; with gastrectomy will have lifelong B12 supplementation
  • holds food while partitions small amounts to go through small intestine so digestion can occur properly
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38
Q

Acid secretion

  • celiac phase: mediated by; triggered by
  • gastric phase: mediated by; triggered by
  • intestinal phase
A
  • mediated by PS; thought/ site/ taste of food causes production of gastric acid
  • mediated by presence of gastrin; chemical stimulus of food and distention of stomach
  • when protein contains food enters duodenum
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39
Q
  • mucous cell: prduce, in response to
  • parietal
  • chief
  • G cells
  • interchromafin cells
  • D cells
A
  • mucus and biarb bc of prostaglandin
  • HCl
  • pepsinogen
  • gastrin
  • histamine -> increase secretion of acid
  • somatostatin -> inhibits secretion of acid and peristalsis
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40
Q

Receptive Relaxation

  • what is it
  • how does it work
  • VIP
A
  • allows stomach to relax in orad region to allow more room for food
  • detect stretch -> send afferent through vagus to brain and efferent through vagus to stomach releasing VIP
  • SM relaxation
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41
Q

Gastric emptying

  • time frame
  • why is it reg
  • slows down bc
  • CCK
  • why acid
A
  • 3 hour
  • allow neutralization of stomach acid duodenum and optimal absorption
  • Acid (myenteric plexus) and fat (CCK)
  • causes gallbladder to contract so bile can enter into duodenum so fat can be broken down into smaller globules and lipase has more SA to breakdown fat
  • acid must be neutralized in order to get more food into duodenum
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42
Q

How is acid produced

  • histamine
  • gastrin
  • Ach
A
  • binds H2 receptor on parietal
  • produced by g cells, binds to parietal cell; also causes release of pepsinogen
  • from vagus; can cut branches of vagus nerve that go to parietal cells
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43
Q

Dumping Syndrome

  • what is it
  • sequelae
  • sxs
A
  • connect duodenum to esophagus
  • no longer have pylorus to partition off amount of food in stomach so now have hyper osmotic in lumen causing water to be dumped into intestine
  • hypovolemia, hypoglycemia (all glucose dumped into duodenum causes lots of insulin to be released), diarrhea, flushing, bloating
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44
Q

Gastrinoma

  • what is it
  • location
  • produces
  • sxs
  • other tests
  • managment
A
  • neuroendocrine tumors, benign lesion
  • pancreas, between pancreas and duodenum, 2nd part of doudoneum
  • gastrin -> no feedback -> excessive acid production
  • ulcers in weird places (NOT in stomach or in 1st portion of duodenum), diarrhea,
  • MEN1 (PTH)
  • PPI and removal if good candidate
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45
Q

Protecting stomach

  • what
  • stimulated by
  • other mech
A
  • mucus
  • prostaglandin -> from AA
  • HCO3 -> neutralizes
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46
Q 
Parietal Cells
- release
- location
- histo
-
A
  • HCl (H/ K on apical side) and IF
    body and fundus
  • eosinophilic sytoplasm, increased mito and internal tubulovesicular sxs
  • Ach on M3, Histamine on H2, and gastrin on gastrin receptor
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47
Q

Tx of acid production

  • antacid
  • milk alkali
  • H2 blockers
  • PPI: MOA, benefit, AE, azole
A
  • mostly use CaCO3
  • drink milk and take a lot of antacids -> overwhelming body w/ Ca
  • only drop by 70%; ranitidine, cimetidine; antisedative, gynecomastia
  • stops production of acid -> 0 acid production occurs; omeprazole and pantoprazole; Ca issues bc no neg feeback from gastrin and it stimulates PTH and also decreases amount of Ca being absorbed; cannot give azole with it bc they need acidic pH to be activated
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48
Q

Systemic mastocytosis

  • what is it
  • sequelae
A
  • prolierfastion of mast cells in BM and other organs causing deposition of nest of mast cells in mucosa
  • produces histamine causing immune reaction; looks like allergic reaction -> will cause hyper-secretion of gastric acid
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49
Q

Zollinger Ellison syndrome

  • what is it
  • leads to
A
  • when excess gastrin is secreted by tumor

- ulcers in weird area or ulcer dx that needs to be given really high dose in order to control

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50
Q

Erosion

  • what is it
  • vs ulcer
A
  • superficial defects that do not go beyond mucosa

- defects through submucosa and can get into muscularis and through serosa to perforate

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51
Q

H. pylori

  • damages
  • tx
  • types of AB
A
  • mucous layer making acid pass through epi cells
  • 2 antibiotics, anti-secretory agent (PPI or H2b blocker) and bismuth (decrease adherence to mucousal cells and damage bacterial cell wall)
  • amox, carithromycin, metro, tetracycline
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52
Q

Diarrhea

  • common causes
  • osmotic
  • secretory
  • toxin
  • viral-bacterial
  • chronic
A
  • infection, toxins, drugs
  • too much in lumen causing water to be secreted to normalize - > will stop if pt stops eating
  • something causing enterocyte to secrete water
  • self limited
  • transient but clears faster with antibiotics if bug is found
  • 3 or more lose stools per day for 3- 4 weeks; lactase def, malabsorption, lax abuse, IBS
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53
Q

Constipation

  • first thought should be
  • other causes
  • idiopathic tx
A
  • drugs (pain meds, iron)
  • neurogenic (SC injury, spinabifida), endocrinpathy (DM), IBS
  • bulk forming lax, dietary mod, increase fluid
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54
Q

Gastritis

  • type a
  • type b
  • causes
  • acute caused by
  • chronic: a, b, ab, chemical
A
  • body
  • antrum
  • upper GI bleeds in children, teens, adults
  • h. pylori, other infections
  • a- AI, b- h. pylori, AB - environmental, chemical - reflux
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55
Q

Peptic Ulcer Dx

  • gastric: location, worse, associated with (2)
  • duodenal: location, improves, worsens, associated, dx
  • noraml sxs
  • alarming sxs: why
A
  • antrum; with meal; H. pylori (70%, urease breath) and CA (20%)
  • duodenal bulb (any other location is suspicious for zollinger-ellison); with meal (pylorus will be shut and no acid is coming into duodenum), 30-45 min after meal (allows for gastric contents to be let in) and night (bc of motilin); H. pylori (95%); urease breath test for H pylori
  • epigastric pain (burning), fullness, bloating, early satiety, nocturnal pain
  • anemia, hematemesis, heme in stool, bloody vomit, persistent abd pain that radiates to back, severe abd pain that spreads; ulcer has eroded
56
Q

Hiatal Hernia

  • what is it
  • sliding: what happens, sequelae
  • rolling: what happens, tx
A
  • whole GE junction moves above diaphragm; GERD

- defect in diaphragm allows for somtach to herniate above diaphragm; surgical correction

57
Q

Gastric CA

  • sxs
  • mets
  • epi
  • risk
  • adeno CA: intestinal, diffuse
  • lintis plastica
  • dx
  • tx
  • prognosis
A
  • abd upset, abd distention, anorexia, weight loss
  • left supraclavicular (virchows), sister mary joseph nodule (umbilical), krukenberg tumor (ovary)
  • men over 50
  • high in salt and fat and low in fiber
  • solid mass that projects into lumen and is glandular columnar or cuboidal cells; infiltrates stomach wall and displays signet ring patter (cells that dont form glands)
  • leather bottle stomach, diffuse infiltrating CA that is rapidly fatal
  • biopsy
  • palliative
  • 5% for 5 yr survival
58
Q

Inguinal Hernia

  • epi
  • presentation
  • tx
  • direct
  • indirect
A

male

  • groin mass
  • surgical correction
  • protrudes directly though abd wall, medial to epigastric a
  • lateral to inf epigastric a and into spermatic cord
59
Q

Femoral Hernia

  • epi
  • sxs
  • tx
  • reducible
  • incarcarated
  • strangulated
A
  • females
  • mass below inguinal ligament and on medial portion of thigh, painful
  • urgent surgery
  • herniated tissue put back in normal location
  • herniated tissue not reducible menually
  • vascular supply is compromised and is ischemic
60
Q

Umbilical Hernia

  • caused by, sxs, tx
  • epi
  • adult equivalent: what is it, tx
A
  • congenital malformation; pt has outtie belly button; usually reduces on own
  • AA
  • paraumbilical, on one side or other instead of midline; surgical repair
61
Q

Menetrier dx

  • what is it
  • parietal cell sequelae
  • sxs
  • associated with
  • tx
A
  • hyperplasia of goblet cells and enlarged rugal folds -> excessive mucus production and protein loss
  • cells atophy -> decreased acid production
  • weight loss, n/v, edema (loss of oncotic pressure)
  • CMV and h pylori
  • cetuximab (mab against EGFR) or
62
Q

Pyloric stenosis

  • what is it
  • when is it seen
  • sxs
  • why
  • PE
A
  • pyloris hypertrophied and blocks outflow of stomach
  • 3rd-4th week of life
  • projectile vomiting
  • stomach has been stretched out from being filled up with past feedings and causes reverse
  • olive sign at epigastrum or to side of epi
  • correct fluid and electrolytes then to surgery
63
Q

Duodenal hormones

  • I cells: produce, which does
  • G cells
  • D cells
  • Pasarsym ganglia
  • small intestine
  • S cells
  • K cells
A
  • CCK; increase GB contration, pancreatic secretion
  • produce gastrin; increase gastric acid secretion; release pepsinogen and acid
  • somatostatin; slow down GI motility and secretion
  • VIP; SM relaxation, and increase secretion of water and electrolytes in intestine
  • motilin; propels GI
  • secretin; increase bile and pancreating HCO3 secretion; acid/fat in duodenum
  • GIP; increase insulin release and decrease gastric acid secretion
64
Q

Structure of small intestine

  • serosa
  • muscularis externa
  • submucosa
  • peyers patches
  • goblet cells
  • paneth cells
A
  • in ileum, jejunum, and 1st part of duodenum; 2nd-4th is adventitia (wet tissue paper consistenct, not able to hold stitches)
  • deep to serose, has inner circular and outter longitudinal layer
  • contain brunners glands (produce alkaline fluid) in duodenum and meissner plexus throughout
  • only in ileum
  • throughout but increase from prox to distal
  • maintain intestinal epi and replenish epithelial cells
65
Q

Duodenal Course

  • 1st part
  • 2nd part
  • 3rd
  • 4th
A
  • duodenal bulb, only part introperitoneal, oriented horizontally
  • goes inferior from L1-L3, location of bile duct
  • horizontal over L3, abd aort and IVC; can get trapped under SMA
  • sourses superior and to left of L2/3 vert and becomes jejunum when it passes ligament of treitz
66
Q

Digestion of small intestine

  • where do enzymes come from
  • activated by
  • enterokinase def: sxs, tx
  • lipid digestion vs absorption
A
  • pancreas
  • trypsin, comes from trypsinogen in pancreas, converted by enterokinase
  • diarrhea, malabsorption, etc; pancrease (pancreatic enzymes in pill form)
  • duodenum vs jejunum; dont need transporter, just diffuse through brush border and then inside are put into chylomicrons to be transported
67
Q

Peristalsis

  • under control of
  • include
  • start -> end
  • hurschprung dx: presentation, imaging, diagnosis, tx
A
  • PS
  • meissner and auerback plexi
  • 8th week - 12th week
  • aganglionosis of rectum; abd distention, no meconium, obstruction; dilation of colon that is atophic; rectal biopsy showing aganglionosis; colostomy bag so baby can evacuate stool, then when older the innervated part sewn down to anus and un-innervated part removed
68
Q

IBD

  • crohns vs UC
  • signs and sxs
  • dx
A
  • affects small intestine but is seen from mouth to anus and has skip lesions; UC only involves large intestine and is continuous
  • abd pain, diarrhea, malabsorption, fever
  • colonoscopy + biopsy (non-caseating granuloma w/ cobblestone mucosa)
  • sulfasalazine, steroid, immunosuppressive agents
69
Q

Small bowel obstruction

  • caused by
  • sxs
  • dx
  • tx: small
  • tx: severe/ septic
A
  • adhesion (scar tissue from previous operation), CA, hernia, inflammation, gallstones, drugs (narcotic and anti-cholinergic)
  • abd pain (crampy, in waves) and distention, tympany, high pitched bowel sound (sounds like glasses clinking together), n/v, lack of flatus
  • xray: w/ mult loops of distended loops of small bowel and upright air fluid level
  • conservative- NPO, NG tube and suck everything out, morphine for pain, saline to keep hydrated
  • surgery required but need to give antibiotics
70
Q

Small Bowel CA

  • sxs
  • dx
  • types
  • tx
A
  • abd pain, weight loss, anemia, vomiting, obstruction
  • biopsy
  • adenocarcinoma, carcinoid, lymphoma and sarcoma
  • resection + LN biopsy
71
Q

Pancreatic embryo

  • dorsal pancreatic bud
  • ventral pancreatic bud
  • fuse
  • annular pancreas: what is it, sxs
A
  • pancreatil tailm body, isthmus, accessory duct
  • head, uncinate
  • at 8 weeks
  • central pancreatic bud cleaves into 2 parts and forms ring around descending portion of duodnenum an fuses with dorsal bud on each side, duodenal stenosis w/ recurrent bilious vommitting
72
Q

Pancreas

  • endocrine function
  • exocrine function
A
  • insulin (beta) and glucagon (alpha), somatostain (delta)

- pancreatic enzymes secreted by acinar cells into descending oart of duodenum

73
Q

Pancreatic Enzymes

  • amylase
  • lipase: function, level, orlistat
A
  • breaks 1,4 glucosidic bond
  • ## hydrolyze dietary fat turning them into monoglycerides and FFA; normally low and if elevated can indicate acute pancreatitis; inhibits pancreatic lipase enzyme leading to decreased abiltiy to breakdown and absorb fat
74
Q

Pancreatitis

  • what is it
  • sxs
  • cause by in children
  • caused by in adults
  • dx
  • mgmnt
  • ransons criteria
  • psudocyst: what is it, sxs, DX, TX
  • acute interstitial: pathogenesis
  • acute necrotic pancreatitis
  • hemmorhagic pancreatitis: what is it; grey turner sign; cullen sign, dx
A
  • inflammation of pancreas
  • mid-epigastric pain that radiates to back
  • abd trauma, infections
  • alcohol, gallstones
  • serum lipase and amylase, abd xray
  • NPO, NG tube, IV NS, opioid,
  • help predict prognosis of pancreatitis; if 3 or more met, then its severe
  • pseduocyst -> collection of pancreatic enzymes, necrotic debris, and hemolyzed blood; mult bouts of pancreatitis mimicking sxs; US; drain w/ sxs
  • obstruction -> stasis of pancreatic secretion -> digestion of adipose cells by lipase -> FA bind to Ca and precipitate insoluble Ca salts -> area of focal necrosis and Ca induce inflammatory reaction -> pancreas edematous
  • inflammation continues -> blood flow slows -> ischemia damages acinar cells -> abnormal intracellular activation of trypsin -> other enzymes activated -> autodigestion; destruction of blood vessels and cause hemmorrhage into necrotic area (looks like chalky fat necrosis)
  • bleeding into retroperitoneal space; flank bruising, periumilical bruising; CT
75
Q

Pancreatic CA

  • presents w
  • risks
A
  • painless jaundice, palpable non-tender gallbladder, weight loss, dark urin, pale stool
  • 65-75 yrs, smoking, diabetes, chronic pancreatitis, genetics
76
Q

D-xylose test

  • function
  • results
A
  • test brush border absorption capabilities

- if microvilli are working then there will be high levels in urine and if not working there will be low levels in urine

77
Q

Zones of liver

  • zone 1: blood flow, function, affected by
  • zone 2
  • zone 3: blood flow, function, affected by
A
  • oxygenated near portal triad; gluconeogenesis, beta oxidation, chol synthesis, glycogen synthesis from lactate, urea cycle; affected by toxins
  • can become zone 1 if necessary; bridging necrosis from hepatitis
  • least oxygenated near central vein; triglyceride synthesis, ketogenesis, glycogen synthesis from glucose, glycolysis, lipogenesis, cytochrome p450 detox; ischemia
78
Q

Steatosis

  • micro: what are they, nucleus,
  • macro: how often, caused by, when does it become problem
A
  • small intra cytoplasmic fat vacuoles that accumulate in cell, do not displace nucleus; reye syndrome, acetminophen tox, pregnany
  • more common; alcoholic obesity; increased FA w/ problem with triglyceride synthesis or elimination; benign until inflammation occurs
  • alcoholic steatosis, alcoholic hepatitic, cirrhosis
79
Q

Gallbladder problems

  • cholelithiasis: what is it, sxs, risk factors, dx, meds, tx, pregnant
  • acute calculous cholecysittis: what is it,
  • cholecystitis: what is it, bugs, sxs, labs, emphesematous
A
  • calcified gallbladder; RUQ cramping pain + normal alk phos -> stone in cystic duct OR RUQ pain + elevated alk phos -> stone in common bile duct; female, forty, fertile, fat; US then HIDA; ursodeoxycholic acid -> breaks up stone; chole, chole during 2nd trimester
  • stone has obstructed in neck of gallbladder or in cystic duct;
  • inflammation of GB due to stone obstruction at GB neck or cystic duct- > disrupts GB mucus layer exposes epi to bile -> gallbladder inglamed; pressure in gallbladder builds up, causes ischemia
  • infection that occurs secondary to obstruction; E. Clo, Enterobacter, Enterococcus, Klebsiella (come from intestine bc of inflammation); severe RUQ pain, murphys sign; elevated WBC w/ elevated alk-phos; caused by clostridium infection of gallbladder; cipro and metro then surgery
80
Q

Pregnancy and OCP use

  • estrogen: what does it do, sequelae
  • progesterone: what does it do, sequelae
A

onfluences cholesterol syn by upregulating the activity of HMGCoA reductase enzyme -> bile become super sat with chol
- reduces bile acid secretion and slows emptying of GB -> GB is hypermotile and w/ too much cholesterol to bile salts cholesterol will precipitate out making stone

81
Q

Total Parenteral Nutrition

  • what is it
  • prolonged causes
  • how
  • ileal resection: what happens, management
A
  • all nutrition coming through IV
  • can cause gallstones to form
  • since not eating anything not producing CCK and so gallbladder sits static which leads to stones
  • disturbs enterohepatic bile acid circulation leading to supersaturation of hepatic bile with chol, exogenous admin of CCK to keep GB from becoming too static
82
Q

Gallstone Ileus

  • what is it
  • how does it get there
  • sequelae
  • sxs
  • dx
  • tx
A
  • large gallstone obstructs the ileocecal valve
  • through cholecyst enteric fistula
  • bowel obstruction
  • n/v, high pitched bowel sounds, cant pass gas
  • upper GI series with air in biliary tree
  • milk the stone back to jejunum, make small incision, push out, sew up, remove fistula and gallbladder
83
Q

Gallbladder Hypomotility

  • what is it
  • caused by
  • what happens
  • slude contains
  • associated with
A
  • slow or icomplete GB emptying
  • CCK resistance
  • bile precipitation with sludge formation,
  • chol monohydrate, calcium bilirubinate and mucus
  • pregnancy, rapid weight loss, prolonged parenteral nutrition, spinal cord injuries
84
Q

Opioids and biliary colic

  • what happens
  • how
  • what to give instead
A
  • can make biliary colic worse
  • binds to mu receptors on sphincter of odi -> causes spasm -> increase pressure in ile duct -> increase pressure in GB -> worsen pain
  • meperidine or NSAID (ketorolac -> injectable, only 5 days)
85
Q

Porcelian Gallbladder

  • seen in
  • what happens
  • sxs
  • dx
  • dx/tx
A
  • pts with chronic cholecysitits, recurrent episodes over time
  • bluish, brittle, calcium laden GB; scared, shrunken, Ca laden
  • episodes of RUQ pain; may feel firm mass in RUQ
  • HIDA
  • endoscopic retrograde cholangiopancreotography; can inject dye to look at anatomy and look for patho, can also do brushing to get cells to check for CA
86
Q

Choledocolithiasis

  • what is it
  • sxs
  • dx
  • tx
A
  • stone in common bile duct -> bile cant get into dudoenum
  • obstructive hjaundice, increased bili, hypercholesterolemia
  • US
  • chole
87
Q

Ascending cholangitis

  • what is it
  • charcot triad
  • reynolds pentad
  • dx
  • tx
A
  • bile flow obstruction -> CBD obstructed -> climbing infection
  • jaundice, RUQ pain, fever
  • 3+ hypotension + alt mental status
  • CBD dilation on US, or ERCP for definitive dx
  • remove stone to decompress biliary tree
88
Q

Primary sclerosing cholangitis

  • type of dx
  • what is it
  • looks like
  • sequelae
  • also usually have
  • epi
A
  • AI
  • inflammation and obstruction of intra and extra hepatic biliary tree
  • narrowings and dilations of biliary tree -> beads on string
  • bile cant get out -> cirrhosis, liver failure, CA
  • IBS, ANCA, ANA
  • men
89
Q

Extrahepatic biliary atresia

  • what is it
  • sxs
  • labs
  • tx
  • prognosis: w/o liver transplant
A
  • congenital obstruction of extrahepatic bile duct
  • juandice by 3rd-4th week life
  • increase bili, alk phos, gamma glutamyl transferase
  • take piece of intestine and sew to liver so that bile can drain like its supposed to; will need transplant at some point
  • survival rate is 30-50%
90
Q 
Gallbladder CA
- epi
- kind
- sxs
- parasite
- courvoisiers law -> sign
-
A
  • female with gallstone hx
  • adeno
  • steady RUQ pain
  • chlonorchis senensis
  • precense of enlarged non tender GB is more like due to CBD obstruction secondary to pancreatic CA; palpable non tender gallbladder
91
Q

Primary biliary cirrhosis

  • type of dx
  • what happens
  • gross findings
  • sxs
  • dx
A
  • AI
  • damages intrahepatic bile ducts -> causes liver damage
  • liver is green
  • pruritis (hyperbilirubinemeia), H/S megaly, xanthomas, jaundice
  • anti- mito antibodies
92
Q

Portal HTN

  • wha is it
  • pre-hepatic
  • intra hepatic
  • post hepatic
  • sxs
  • management
  • side effect of management
A
  • greater than 5 mmHg in portal v
  • portal v thombosis, congenital atresia
  • cirrhosis, hepatic fibrosis
  • hepatic v thrombosis, IVC thrombosis, IVC congenital malformation
  • ascites, splemoegaly, varices, hepatocellular encephalopathy
  • TIPS: go through jugular v and into vena cava -> into the hepatic v -> take needle and go across parenchyma to get to portal v -> place stent between hepatic and portal v
  • decreases ability of liver to get rid of ammonia because blood is being pumped straight back into IVC instead of being filtered in liver
93
Q

Bile Acid binders

  • MOA
  • examples
  • extra benefit
A
  • block reabsorption of bile acid in liver -> contain Cl which is exchanged for bile acid in gut, and bile is excreted out through poop
  • cholestipol and cholestyramine
  • upreg LDL recepetor
94
Q

Lipoproteins

  • function
  • chylomicrons: function
  • VLDL: what does it have on surface; location transports, activated by, turns into
  • IDL: function, turns into, how
  • LDL: function, get into cell
  • HDL: function,
A
  • delivery triglycerides and cholesterol from liver to tissue
  • carry lipids absorbed through GI system -> transport TG to peripheral tissue (adipose, cardiac, skeletal) and cholesterol to liver
  • apoB, cholesterol, TG, apoC2 (needed for LPL) and Apo E (needed for hepatic uptake); from liver to tissues; glycoprotein lipase on endo cells -> release FFA turns into IDL
  • takes triglycerides and cholesterol back to liver; hepatic lipase turns to LDL
  • delivers chol to cells; endocytosis
  • transports chol back to liver
95
Q

Lipid Lowering Drugs

  • bile acid binders
  • statins
  • nicotinic acid (niacin)
  • fibrin acid
  • fish oil
A
  • promotes excretion of bile and liver has to make more so uses stores of chol
  • HMG CoA reductase inhibitos -> doesnt allow for liver to make cholesterol
  • directly decreases synthesis VLDL
  • activate PPR gamma and stimulates genes for lipid metabolism
  • increase TG breakdown and decrease synthesis
96
Q

Familial Hypercholestolemia

  • what is it
  • class 1
  • class 2
  • class 3
  • class 4
  • class 5
  • signs
  • increased risk
  • manage’
A
  • AD, chrom 19 -> causes very high LDL levels
  • LDLr absent
  • LDLr not transported
  • LDL cannot bind to receptor
  • LDLr binds to LDL but cannot endocytose it
  • LDLr not recycled
  • xanthomas
  • cardiovasc dx
  • heterozygous can be managed with statins; homo will treat with high level of statin or statin + ezetimibe
97
Q

Hyperlipidemia

  • what is it
  • causes
  • type 1
  • type 2a
  • type 2b
  • type 3
  • type 4
  • type 5
A
  • defect in lipoprotein metabolism
  • elevated TG, lipids, or both
  • elevated chylomicron bc of defective lipoprotein lipase
    increased LDL bc non functional receptor
  • over production of VLDL by liver and increased LDL bc of receptor inefficiency
  • IDL elevated by lack of ApoE
  • Increased VLDL bc of LPL problem
  • Increased VLDL and chylomicrons bc of decrease in apo C2 (co factor for LPL)
98
Q

Hypertriglyceridemia

  • what is it
  • sxs with severe
  • caused by
  • meds
A
  • elevated TG
  • lipemia retinalis and eruptive xanthomas
  • lifestyle
  • fibrins, statins, niacin
99
Q

Jaundice

  • unconj: location
  • conj
A
  • pre-hepatic (hemolysis), indirect (not water soluble, in blood but not in urine)
  • intahepatic or post, direct, (water soluble, will be in urine)
100
Q

Gilbert Syndrome

  • what happens, when
  • sxs
A
  • UDP-glucouronyl transferase present but stops working under stress
  • mild unconj bili under stress
101
Q

Criggler-Najjar syndrome type 1

  • what happens
  • prognosis
A
  • missing UDP glucuronyl transferase -> cant conjugate

- death in a few years

102
Q

Criggler Najjar type 2

  • what happens
  • management
A
  • not 2 much enzyme, conjugate some bili but not all

- phenobarbital -> increase Cl flux decreases excitability ;cyto P450 inducer

103
Q

Dubin-Johson

  • what happens
  • deposits -> gross
  • dx
  • diff from rotor
A
  • conjugates bili but cant get across canalicular membrane into duct
  • in lysosome -> liver turns black from epi metabolites
  • ratio of corporphyrin 3 and 1 -> usually have more 3 but will be reversed
  • similar, except liver is normal colored
104
Q

Cholestatic Jaundice

  • caused by
  • newborn
  • children/ adults
  • adults
A
  • obstruction to bile flow
  • choeductal cyst (cyst in common bile duct) or biliary atresia
  • pancreatitis, gallstone, sclerosing cholangitis
  • pancreatic CA
105
Q

Halothane

  • what is it
  • labs
A
  • inha;ed anesthetic that has highly fulminant hepatitis

- high AST, ALT, eosionophilia, prolonged PT thime bc clotting factors cant be made by liver

106
Q

Alcohol induced fatty liver

  • what is it
  • epi
  • stain with
A
  • when alcohol is metabolized there is increase in NADH which shuts off TCA and stops beta oxidation leading to fat storage
  • cytoplasmic vacuoles filled with fat
  • sudan black or oil red
107
Q

Benign Hepatic tumor

  • cavernous hemangioma: epi, worried about, sxs, dx, tx
  • hepatic abcess: secondary to, US shows, sxs, tx
A
  • women on OCP; rupture with excessive bleeding; RUQ pain; US; surgery; blood filled vasc space of variable size lined by single epi layer
  • bacterial infection from another place; fluid filled cavity; fever, chill RUQ pain; drain
108
Q

Malignant hepatic tumor

  • mcc
  • hepatocellular carninoma: associated w/ caused by,
A
  • met

- cirrhosis, hep C/B, alcoholism, wilsons dx;

109
Q

Colon

  • function
  • ascending: pumps
  • transverse
  • sigmoid
  • rectum
A
  • reabsorb water
  • Na/ K pumps, stimulated by aldosterone, kicks out Na and water follows; semi-solid stool
  • primary (mediated by hollstra) and secondary peristalsis (based on stretch)
  • stores stool
  • stretch receptors activated and signals you need to go to the restroom; can contract and push back into sigmoid colon for later
110
Q

Volvulus

  • what is it
  • sequelae
  • location
  • sxs
  • imaging
  • management
A
  • intestine will twist upon itself on mesentary
  • obstruction of GI tract or ischemia
  • ileum from congenital malrotation or in sigmoid colon (redundant -> big and floppy and easy to twist)
  • currant jelly stool (blood and mucus)
  • x-ray will see kidney bean shaped intestine
  • resection of volvulized intestine, must stay twisted to prevent re-perfusion injury
111
Q

Intussusception

  • what is it
  • epi
  • location
  • sxs
  • imaging
  • caused by
  • management
A
  • telescoping of one segment of bowel into another
  • children
  • ileocecal junction
  • n/v, sausage shaped mass, current jelly stool
  • US, bulls eye appearance
  • polyp, CA, after viral infection,
  • reduce intussception and resect
112
Q

Diverticulosis

  • what is it
  • risk factor
  • caused by
  • sxs
  • itis: caused by, sxs, complications
A
  • presence of diverticula in colon
  • older than 60, poor diet (low fiber)
  • increased intraluminal pressure + focal weakness of colonic wall
  • painless bleeding
  • piece of stool getting caught in outpouching -> pressure increases -> compromises blood flow; LLQ pain; perforation, peritonitis, abcess, stenosis of bowel, colovesicular fistula (pneumoturia, pass feces through urine, colonized with bugs from colon); removed diseased part of colon
113
Q

Polyp

  • inflammatory: caused by, histo
  • hyperplastic: histo
  • lymphoid: epi, histo
  • hamartomas: histo, occur
  • neoplastic: epi, location, types
  • presentation
A
  • UC and Crohns; composed of regenerating intestinal mucosa
  • composed of well diff mucousal cells that form glands and crypts
  • children, consist of intestinal mucosa infiltrates w/ lymphocytes
  • mucousal glands, SM cells, CT that occurs sporadically
  • seen after 55yrs, most in sigmoid/ rectum; most common is tubular, tubulovillous, and villous
  • lower GI bleed, partial intestinal obstruction, large amount of mucus secretion
114
Q

Familial Adenomatous Polyposis

  • genetic
  • what happens
  • Garnder
  • Turcot
  • Putz-Jeghers
  • Juvenile Polyposis
A
  • AD, APC gene inheritance
  • pt develops several polyps throughout colon and rectum
  • polyposis, desmois tumor, osteoma of mandible/skull, sebaceous cyst
  • polyposis + medulloblastoma or glioma
  • AD, non-neoplastic hamartomatous polyps in stomach, intestine, colon, skin; freckling of lip
  • mult polyps in GI tract of child/ young adult; > 5 polyps in colon/rectum; juvenile polyps throughout GI tract; any number of polyps w fam hx of juvenile polyposis
115
Q

GI hemm

- causes of lower

A
  • diverticulosis, angiodysplasia, UC, ischemic colitis, ulceration
  • red blood in stool
116
Q

Rectal bleeds

  • sxs
  • caused by
A
  • red blood when wipe

- hemmorrhoids, fissures, CA, polyps

117
Q

Large Intestine Obstruction

  • location
  • MCC
  • sxs
  • dx
  • management
  • pseudo obstruction
A
  • sigmoid
  • adenocarcinoma, scarring secondary to diverticulitis, volvulus
  • n/v, crampy abd pain and distention
  • distended prox colon with air fluid levels and no gas in rectum
  • emergency laparatomy w/ perforation (w/ free air on diaphragm)
  • look like obstruction pt but when scoped there is non; paralysis of colonc -> no peristalsis; pt on chronic opioid and anti-cholinergics; colonoscopy and decompression
118
Q

Colon CA

  • risks
  • right sided
  • left sided
A
  • genetic, over 60, low fiber, high fat / cholesterol/ carbs, IBD
  • no obstruction, iron def anemia; anorexia, malaise, and weight loss
  • narrow lumen, sxs partial intestinal obstruction; changes in stool caliber, constipation, cramping abd pain, abd distention, and n/v
119
Q

Lynch Syndrome

  • epi
  • side
  • mutation
  • 1
  • 2
A
  • under 50
  • right
  • auto dom; DNA mismatch repair (MLH1, MSH2, MSH6, PMS2)
  • predisposition to colon adenocarcinoma
  • predisposition to colon CA with features of lynch 1 and increased incidence of extra intestinal CA
120
Q

Colon CA signs and sxs

  • bowel
  • weight
  • bleed ->
  • pain
A
  • alternating
  • weight loss
  • bleeding from lower GI
  • melena
  • abd pain
  • abd distention
  • anemia, fatigue, pallor
121
Q 
Colon screening
- no risk
- w/ risk factors
- dx
-
A
  • start at 50, with colonoscopy every 10 and sigmoid every 5 yrs
  • start at 40 yrs old or 10 yrs before onset of family member affected
  • biopsy
122
Q

hemmorhoids

  • internal
  • external
  • caused by
  • degree
  • dx
  • tx
A
  • above dentate line, not painful -> viscerally innervated
  • below dentate line, painful -> somatic innervation
  • congestion of veins in hemorrhoidal plexus, bc of constipation and increase in pressure squeezing and not allowing drainage
  • 1: no prolapse, 2: prolapse with defecation then returns on own, 3: prolapse with defecation that requires manual reduction, 4: always prolapsed, unable to be reducible manually
  • DRE
  • increase fiber, drink more water, use sitz bath (pt sits in warm water 3x a day and after bowel movement, keeps area clean), proctocream (lidocaine mixed with steroids (numbs and decreases inflammation); internal is removed surgically
123
Q

anal fistula

  • what is it
  • result of
  • patho
  • sequelae
  • management
A
  • connection between rectum and perianal skin
  • anal crypt infection
  • anal crypt becomes infected and an abcess forms and ruptures forming connection between anus and perianal skin
  • perianal skin scars down, then ruptures, drains (intermittent purulent discharge)
  • can erode into
  • remove tunnel and allow it to fill in
124
Q

Anal fissure

  • what is it
  • location
  • caused by
  • sequelae
  • sxs
  • tx
A
  • longitudinal tear in anal mucosa
  • posterior midline, near anal verge
  • irritation and breakage of canals epi; diarrhea, constipation, excessie anal tension or trauma
  • spasm of internal anal sphincter which is painful
  • tearing pain + bright red blood per rectum (drops of blood into toilet water or when wiping)
  • anoscopy
  • stool softener, increase fluids, avoid constipating foods, add fiber, sitz bath
125
Q

CA of rectum

  • type
  • epi
  • sxs
  • dx
  • tx
  • lymph invovlement
A
  • adeno
  • female
  • rectal bleeding, alt bowel habits, obstruction, tenesmus (feeling you have to defecate but dont)
  • colonoscopy
  • surgery -> save anal sphincter
  • add radiation and 5 FU
126
Q

CA of anus

  • type
  • risks
  • sxs
  • managment
A
  • squamous cell
  • crohns, fistula, abcess, infection
  • mucus evacuation with feces
  • chemo and radiation -> shrink -> then excise
127
Q

Appendix

  • what is it
  • itis patho
  • mcburneys point
  • sxs
  • sign
  • managment
A
  • appendage attached to base of cecum
  • inflammation caused by piece of stool obstucting opening -> continues to produce mucus -> increase in pressure -> becomes edematous and activates visceral pain receptors (non specific peri-umbilical pain -> compromised blood flow -> ischemic / necrotic (somatic innervation impacted and pain localizes at mcburneys point)
  • 2/3 away from umbilicus towards ASIS
  • n/v, diarrhea, fever, annorexia
  • psoas sign (straight leg illicits RLQ pain), obturator sign flex at hip and knee, internal rotate with pain in RLQ, rothburg - palpate LLQ and feel pain in RLQ
  • NPO, NG tube, IV NS, Meperidine, appendectomy
128
Q

Crohns

  • epi
  • starts as
  • whats involved
  • starts with
  • protein involved
  • normal immune response is
  • pathogenesis
  • extra intestinal mainfestations
A
  • 20-30 yrs
  • abd pain, diarrhea, weight loss, low grade fever, aphthuous ulcer of oral mucosa
  • entire GI wall is inflammed
  • terminal illetus
  • NK-kappaB increased activity
  • blunted, microbes persist, induce chronic inflamm
  • increased activity of Th1 helper cells -> increase production of IL-2, INF gamma, and TNF -> ganulomas
  • erythema nodusum, arthritis, ankylosing spondylitis, fistulas, strictures, abcesses, peri-anal dx
  • non-caseating granuloma and cobblestone appearance -> long linear ulcers
129
Q

Ulcerative Colitis

  • hallmark finding
  • whats involved
  • histo
  • complication
A
  • bloody diarrhea w or w/o abd pain
  • rectum and large intestine only
  • continuous damage
  • ## toxic megacolon (dilation in transverse colon) -> surgery and antibiotics
130
Q

C diff

  • gram
  • respiration
  • forms
  • causes
  • sxs
  • how to avoid
  • prevent with
  • dx
  • tx
A
  • +
  • anaerobe
  • spore forming
  • anti-biotic pseudomembranous colitis
  • toxin causes diarrhea, bloating abd pain
  • wash hands
  • cytotoxic assay, stool leukocyte measurements
  • metro and vanco
131
Q

Derm Herpetiformis

  • sxs
  • distribution
  • type
  • histo
  • sxs
A
  • group of small vessicles that occur on extensor surfaces
  • symmetric
  • AI
  • PMN and fibrin at tips of dermal papillae
  • diarrhea, steatorrhea, other malabsorption
132
Q

Tropical Sprue

  • what is it
  • infection
  • sxs
  • causes
A
  • malabsorption dx commonly found in tropical region
  • infection of flat villi
  • diarrhea/ steatorrhea, fever, malaise
  • fat soluble deficiency, vit b 12 deficiency
133
Q

Lactose Intolerance

  • primary
  • secondary
  • normally
  • sxs
A
  • genetic, asian and african
  • MC a response to intestinal mucousal dx
  • degenerates with age
  • GI upset upon ingestion of food with lactose
134
Q

Necrotizing Enterocolitis

  • what happens
  • epi
  • caused by
  • imaging
  • patho finding
  • gas bowel; how
A
  • portions of bowel undergo necrosis
  • premature infants
  • lack pf developed blood vessels
  • fixed loop, w/ unilateral gas-filled loop of bowel
  • pneumatosis intestinalis -> gas within wall of small intestine -> look like gas cyst; air is produced by bacteria residing in bowel wall
135
Q

IBS

  • epi
  • triggers
  • sxs
  • dx
  • managment
A
  • females, 20’s
  • stress/ anxiety related
  • constipation/ diarrhea
  • exclusion
  • fiber supplements
136
Q

Whipple Dx

  • what is it
  • caused by
  • epi
  • sxs
  • other damage
  • dx
  • tx
A
  • small intestines cannot absorb nutrients
  • tropheryma whipplei
  • middle age males
  • joint pain
  • heart, brain
  • small bowerl biopsy -> + for periodic acid schiff staining
  • cephalosporin
137
Q

Whipple Dx

  • what is it
  • caused by
  • epi
  • sxs
  • other damage
  • dx
  • tx
A
  • small intestines cannot absorb nutrients
  • tropheryma whipplei
  • middle age males
  • joint pain
  • heart, brain
  • small bowerl biopsy -> + for periodic acid schiff staining
  • cephalosporin followed w/ one year TMP-sulfa

Boards II (20 decks)

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